Implications of Major Learning Theories for Online Medical Education: A Narrative Review

Document Type : Review Article

Authors

1 Student Research Committee of Shiraz University of Medical Sciences, Shiraz, Iran

2 Department of E-Learning in Medical Sciences, Virtual School and Center of Excellence in E-Learning, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract

Background: Online education has transformed learning by enabling participation regardless of geographical or temporal constraints. However, effective online instruction requires alignment with learning theories to meet learners' needs. This narrative review examined the major learning approaches (behaviorism, cognitivism, constructivism, and connectivism) and their implications for online medical education.
Methods: A narrative review of the literature from 2000 to 2023 was conducted using ERIC, Scopus, Google Scholar, and ProQuest. The inclusion criteria consisted of peer-reviewed articles focusing on learning theories in higher education, while the exclusion criteria ruled out non-English studies and those lacking empirical or theoretical analysis. Data were synthesized to compare the four learning theories, identifying aspects of their approaches, implications, strengths, and limitations in online medical education.
Results: This review synthesized 59 studies on four learning theories in online medical education. Behaviorism emphasizes structured, measurable outcomes through multimedia and skill reinforcement but overlooks cognitive processes. Cognitivism enhances critical thinking through case studies and simulations, though internal mental processes are difficult to quantify. Constructivism promotes active, collaborative learning through real-world scenarios but requires a shift towards student-centered methods. Connectivism leverages digital networks for self-directed learning but demands high digital literacy and is challenging to implement in traditional settings. Each approach offers distinct strengths and limitations for the design of medical education.
Conclusion: The fundamental ideas and structures of various schools of thought share similarities, providing an opportunity to incorporate principles from different approaches into online medical education materials. Learning theories can be utilized for selecting appropriate practice for various learning goals.

Highlights

Zahra Zolfaghari (Google Scholar)

Zahra Karimian (Google Scholar)

Keywords


  1. Gilbert B. Online learning revealing the benefits and challenges. 2015.
  2. Andrews R. Does E-Learning Require a New Theory of Learning? Some Initial Thoughts. Journal for Educational Research Online. 2011;3(1):104-21. doi: 10.25656/01:4684.
  3. Pange A, Pange J. Is E-Learning Based on Learning Theories? A Literature Review. World Academy of Science Engineering and Technology. 2011;5(8):56-60.
  4. Anderson T. The Theory and Practice of Online Learning: AU Press, Athabasca University; 2011. p. 484.
  5. Arghode V, Brieger EW, McLean GN. Adult learning theories: implications for online instruction. European Journal of Training and Development. 2017;41)7(:593-609.  doi:10.1108/EJTD-02-2017-0014
  6. Donkin R, Yule H, Fyfe T. Online case-based learning in medical education: a scoping review. BMC Med Educ. 2023;23(1):564. doi: 10.1186/s12909-023-04520-w. PubMed PMID: 37559108; PubMed Central PMCID: PMC10413534.
  7. Delungahawatta T, Dunne SS, Hyde S, Halpenny L, McGrath D, O'Regan A, Dunne CP. Advances in e-learning in undergraduate clinical medicine: a systematic review. BMC Med Educ. 2022;22(1):711. doi:10.1186/s12909-022-03773-1. PubMed PMID: 36207721; PubMed Central PMCID: PMC9540295.
  8. Badyal DK, Singh T. Learning theories: the basics to learn in medical education. Int J Appl Basic Med Res. 2017;7(Suppl 1):S1. doi: 10.4103/ijabmr.IJABMR_39_17. PubMed PMID: 29344448; PubMed Central PMCID: PMC5778964.
  9. Torre DM, Daley BJ, Sebastian JL, Elnicki DM. Overview of current learning theories for medical educators. Am J Med. 2006;119(10):903-7. doi: 10.1016/j.amjmed.2006.06.037. PubMed PMID: 17000220.
  10. Chen JC. Teaching nontraditional adult students: Adult learning theories in practice. Teach High Educ. 2014;19(4):406-18. doi: 10.1080/13562517.2013.860101.
  11. Braat M, Engelen J, van Gemert T, Verhaegh S. The rise and fall of behaviorism: The narrative and the numbers. Hist Psychol. 2020;23(3):252. doi: 10.1037/hop0000142.
  12. Rumbaugh DM. Emergents and rational behaviorism. Psi Chi, the International Honor Society in Psychology. 2002;6(2). doi: 1092-0803.Eye6.2.8.
  13. Reimann A. Behaviorist Learning Theory. TESOL Encycl Engl Lang Teach. 2018;12:1-6. doi: 10.1002/9781118784235.eelt0155.
  14. Araiba S. Current diversification of behaviorism. Perspect Behav Sci. 2020;43(1):157-75. doi: 10.1007/s40614-019-00222-1.
  15. Ally M. Foundations of educational theory for online learning. In: Anderson T, editor. The Theory and Practice of Online Learning. Athabasca, Alberta: Athabasca University; 2008:1-22
  16. Bacanlı H. Behaviorist approach. U Z Kaya, S Akdemir (ur), Learning and teaching: Theories, approaches and models. 2016:19-30.
  17. Muhajirah M. Basic of Learning Theory: (Behaviorism, Cognitivism, Constructivism, and Humanism).  Int J Asian Educ. 2020;1(1):37-42. doi: 10.46966/ijae.v1i1.23.
  18. Nevin JA. Analyzing Thorndike’s law of effect: The question of stimulus—response bonds. J Exp Anal Behav. 1999;72(3):447-50. doi: 10.1901/jeab.1999.72-447. PubMed PMID: 10682343.
  19. Brau B, Fox N, Robinson E. Behaviorism. In R. Kimmons, The Students' Guide to Learning Design and Research. EdTech Books. 2018. Available from https://edtechbooks.org/studentguide/behaviorism.
  20. Morris EK, Smith NG, Altus DE. BF Skinner’s contributions to applied behavior analysis. Behav Anal. 2005;28:99-131. doi: 10.1007/BF03392108. PubMed PMID: 22478429; PubMed Central PMCID: PMC2755377.
  21. Malone JC. Did John B. Watson really “found” behaviorism? Behav Anal. 2014;37(1):1-12. doi: 10.1007/s40614-014-0004-3. PubMed PMID: 25264491; PubMed Central PMCID: PMC4883492.
  22. Tadayon R. Bandura’s social learning theory & social cognitive learning theory. SimplyPsychology; 2023 March 20. [Cited 2023 May 10]. Available from: www.simplypsychology.org/bandura.html.
  23. Reimann A. Behaviorist learning theory. TESOL Encycl Engl Lang Teach. 2018:1-6. doi: 10.1002/9781118784235.eelt0155.
  24. Utami BNP, editor The Behaviorism Perspectives on English Learning: Its Theorical and Implications for Foreign English Learner in Online Learning Era. Proceeding of International Conference on Islamic Education; 2021.
  25. Malikowski SR, Thompson ME, Theis JG. A model for research into course management systems: J Educ Comput Res. 2007;36(2):149-73. doi: 10.2190/EC.36.2.c.
  26. Zhou M, Brown D. Educational Learning Theories: 2nd Edition: Education Open Textbooks; 2015. Available from: https://oer.galileo.usg.edu/education-textbooks/1.
  27. Hodges BD, Kuper A. Theory and practice in the design and conduct of graduate medical education. Acad Med. 2012;87(1):25-33. doi: 10.1097/ACM.0b013e318238e069. PubMed PMID: 22104048.
  28. Nalliah S, Idris N. Applying the learning theories to medical education: A commentary. educational psychology. 2014;8(1):50-7.
  29. Lilienfeld SO. Psychology: A framework for everyday thinking. London: Pearson; 2010.
  30. Clark KR. Learning Theories: Cognitivism. Radiol Technol. 2018;90(2):176-179. PubMed PMID: 30420575.
  31. Al-Jarrah TM, Mansor N, Talafhah RH, Al-Jarrah JM. The application of metacognition, cognitivism, and constructivism in teaching writing skills. Eur J Foreign Lang Teach. 2019;3(4):199-213.  doi: 10.5281/zenodo.2531616.
  32. Bandura A. An Introduction to Theories of Personality: 7th ed. London: Psychology Press; 2010. P. 341-60. doi: 10.4324/9781315793177.
  33. So I. Cognitive development in children: Piaget development and learning.  J Res Sci Teach. 1964;2(3):176-86. doi:10.1002/tea.3660020306.
  34. Mcleod S. Vygotsky’s sociocultural theory of cognitive development. Simply Psychology; 2023 March 06. [Cited 2023 May 18]. Available from: https://www.simplypsychology org/vygotsky html.
  35. Ozdem-Yilmaz Y, Bilican K. Discovery Learning—Jerome Bruner. In: Science Education in Theory and Practice: An Introductory Guide to Learning Theory. 2020:177-90. doi: 10.1007/978-3-030-43620-9_13.
  36. Agra G, Formiga NS, Oliveira PSd, Costa MML, Fernandes MdGM, Nóbrega MMLd. Analysis of the concept of Meaningful Learning in light of the Ausubel’s Theory.  Rev Bras Enferm. 2019;72(suppl 2):248-55. doi:10.1590/0034-7167-2018-0624. PubMed PMID: 31420779.
  37. Efgivia MG, Ukhrowati U, Ulfah M, Fitriah M, editors. Implementation of Cognitivism Theory in the Learning Process at Riyadlul Jannah Middle School in the Pandemic Era. 1st UMGESHIC International Seminar on Health, Social Science and Humanities (UMGESHIC-ISHSSH 2020); 2021: Atlantis Press.
  38. Koch I, Poljac E, Müller H, Kiesel A. Cognitive structure, flexibility, and plasticity in human multitasking—An integrative review of dual-task and task-switching research. Psychol Bull. 2018;144(6):557-83. doi:10.1037/bul0000142. PubMed PMID: 29985692;
  39. Touya G, Zhang X, Lokhat I. Is deep learning the new agent for map generalization? Int J Cartogr. 2019;5(2-3):142-57. doi:10.1080/23729333.2019.1613071.
  40. Lachman R, Lachman JL, Butterfield EC. Cognitive psychology and information processing: An introduction. New York: Psychology Press; 2015. doi: 10.4324/9781315798844.
  41. Qiao YQ, Shen J, Liang X, Ding S, Chen FY, Shao L, Zheng Q, Ran ZH. Using cognitive theory to facilitate medical education. BMC Med Educ. 2014;14:79. doi: 10.1186/1472-6920-14-79. PMID: 24731433; PMCID: PMC3989791.
  42. Kaufman DM, V Mann K. Teaching and learning in medical education: how theory can inform practice. Understanding medical education: evidence, theory, and practice. 2018:37-69. doi: 10.1002/9781118472361.ch2.
  43. Troelstra AS. History of constructivism in the 20th century. Set Theory, Arithmetic, and Foundations of Mathematics. 2011:150-79. doi:10.1017/CBO9780511910616.009.
  44. Wrenn J, Wrenn B. Enhancing learning by integrating theory and practice. Int J Teach Learn High Educ. 2009;21(2):258-65.
  45. Ültanir E. An epistemological glance at the constructivist approach: Constructivist learning in Dewey, Piaget, and Montessori. Int J Instr. 2012;5(2):195-212.
  46. Mattar J. Constructivism and connectivism in education technology: Active, situated, authentic, experiential, and anchored learning. Rev Iberoam Educ Distancia. 2018;21(2):201-17.  doi:10.5944/ried.21.2.20055.
  47. Vygotsky L, Cole M. Lev Vygotsky: Learning and social constructivism. Learning theories for early years practice. 2018;66:58.
  48. Rannikmäe M, Holbrook J, Soobard R. Social Constructivism—Jerome Bruner. In: Science Education in Theory and Practice: An Introductory Guide to Learning Theory. 2020:259-75. doi:10.1007/978-3-030-43620-9_18.
  49. El-Beheiry M, McCreery G, Schlachta CM. A serious game skills competition increases voluntary usage and proficiency of a virtual reality laparoscopic simulator during first-year surgical residents’ simulation curriculum. Surg Endosc. 2017;31(4):1643-50. doi:10.1007/s00464-016-5250-9. PubMed PMID: 27649516.
  50. Al-Huneidi A, Schreurs J. Constructivism based blended learning in higher education. Int J Emerg Technol Learn (IJET). 2012;7(1):4-9. doi: 10.3991/ijet.v7i1.1792.
  51. Coman C, Țîru LG, Meseșan-Schmitz L, Stanciu C, Bularca MC. Online teaching and learning in higher education during the coronavirus pandemic: Students’ perspective. Sustainability. 2020;12(24):10367.doi:10.3390/su122410367.
  52. Bawa N, Zubairu S. Constructivism and classroom interaction. Int J Mod Soc Sci. 2015;4(2):71-81.
  53. Elliott-Kingston C, Doyle OP, Hunter A, editors. Benefits of scenario-based learning in university education. XXIX International Horticultural Congress on Horticulture: Sustaining Lives, Livelihoods and Landscapes (IHC2014): Plenary 1126; 2014.
  54. Hassan SS, Nausheen F, Scali F, Mohsin H, Thomann C. A constructivist approach to teach neuroanatomy lab: students’ perceptions of an active learning environment. Scott Med J. 2022;67(3):80-6. doi:10.1177/00369330211009933. PubMed PMID: 35177906.
  55. Rojanasarot S, Milone A, Balestrieri R, Pittenger AL. Personalized learning in an online drugs and US health care system controversies course. Am J Pharm Educ. 2018;82(8):6391. doi:10.5688/ajpe6391. PubMed PMID: 30359548; PubMed Central PMCID: PMC6196326.
  56. Jin J, Bridges SM. Educational technologies in problem-based learning in health sciences education: a systematic review. J Med Internet Res. 2014;16(12):e251. doi:10.2196/jmir.3457. PubMed PMID: 25470407; PubMed Central PMCID: PMC4307819.
  57. Goldie JGS. Connectivism: A knowledge learning theory for the digital age? Med Teach. 2016;38(10):1064-9. doi:10.1080/0142159X.2016.1173661. PubMed PMID: 27343298.
  58. Mehrfar A, Zolfaghari Z, Hejazi Y, Zarifsanaiey N. Ethical Principles in E-Learning; Investigating Key Issues in Instructional Design and Teaching Methods: A Narrative Review. Interdiscip J Virtual Learn Med Sci. 2023;14(4):251-62. doi:10.30476/ijvlms.2023.98331.
  59. Duke B, Harper G, Johnston M. Connectivism as a digital age learning theory. Int HETL Rev. 2013 (Special Issue):4-13.
  60. Utecht J, Keller D. Becoming Relevant Again: Applying Connectivism Learning Theory to Today’s Classrooms. Crit Quest Educ. 2019;10(2):107-19.
  61. Betts GT, Carey RJ, Kapushion BM. Autonomous learner model resource book. London: Routledge; 2021.
  62. Raushan A. ICT enabled classroom for creating Autonomous learner: Issues and Challenges. Educ Resurgence J. 2020;2(3):58-64.
  63. Baturay MH. An overview of the world of MOOCs. Procedia-Social and Behavioral Sciences. 2015;174:427-33. doi:10.1016/j.sbspro.2015.01.670.
  64. Tinmaz H. Social networking websites as an innovative framework for connectivism. Contemp Educ Technol. 2012;3(3):234-45.2012;3(3):234-45. doi:10.30935/cedtech/6080.
  65. Ozturk HT. Examining value change in MOOCs in the scope of connectivism and open educational resources movement. IRRODL. 2015;16(5):1-18. doi: 10.19173/irrodl.v16i5.2027.
  66. Sozudogru O, Altinay M, Dagli G, Altinay Z, Altinay F. Examination of connectivist theory in English language learning: The role of online social networking tool. Int J Inf Learn Technol. 2019;36(4):354-63. doi:10.1108/IJILT-01-2019-0006.
  67. Vas R, Weber C, Gkoumas D. Implementing connectivism by semantic technologies for self-directed learning. Int J Manpow. 2018;39(8):1032-46. doi:10.1108/IJM-06-2017-0135.
  68. Aveiro-Róbalo TR, editor Distance learning and its relation to medical education in the present times. Semin Med Writ Educ. 2022;1:10. doi:10.56294/mw202210.
  69. Lee JX, Ahmad Azman AH, Ng JY, Ismail NAS. Reflection of connectivism in medical education and learning motivation during COVID-19. medRxiv. 2020. doi:10.1101/2020.07.07.20147918.
  70. Suwannaphisit S, Anusitviwat C, Hongnaparak T, Bvonpanttarananon J. Expectations on online orthopedic course using constructivism theory: A cross-sectional study among medical students. Ann Med Surg (Lond). 2021;67:102493. doi:10.1016/j.amsu.2021.102493. PubMed PMID: 33896470; PubMed Central PMCID: PMC8082204.
  71. Ruiz JG, Mintzer MJ, Leipzig RM. The impact of e-learning in medical education. Acad Med. 2006;81(3):207-12. doi:10.1097/00001888-200603000-00002. PubMed PMID: 16501333.
  72. Masters K, Correia R, Nemethy K, Benjamin J, Carver T, MacNeill H. Online learning in health professions education. Part 2: Tools and practical application: AMEE Guide No. 163. Med Teach. 2024;46(1):18-33. doi:10.1080/0142159X.2023.2259069.
  73. Yilmaz K. The cognitive perspective on learning: Its theoretical underpinnings and implications for classroom practices. The Clearing House: A Journal of Educational Strategies, Issues and Ideas. 2011;84(5):204-12. doi:10.1080/00098655.2011.568989.
  74. Conway C, Edgar S, Hansen E, Palmer CM. Book review: Learning in adulthood: A comprehensive guide. Journal of Music Teacher Education. 2012; 21(2):69-81. doi:10.1177/1057083710397590.
  75. Arghode V, Wang J. Exploring trainers’ engaging instructional practices: a collective case study.Eur J Train Dev. 2016;40(2):111-27. doi:10.1108/EJTD-04-2015-0033.
  76. Kropf DC. Connectivism: 21st Century’s New Learning Theory. Eur J Open Distance E-Learn. 2013;16(2):13-24.